The Association between Care Experiences and Parent Ratings of Care for Different Racial, Ethnic, and Language Groups in a Medicaid Population

Authors

  • Victoria Wilkins,

    1. Department of Inpatient Medicine, University of Utah, 100 Mario Capecchi Drive, Salt Lake City, UT 84113
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    • Address correspondence to Victoria Wilkins, M.D., M.P.H., Department of Inpatient Medicine, University of Utah, 100 Mario Capecchi Drive, Salt Lake City, UT 84113; e-mail: victoria.wilkins@hsc.utah.edu. Marc N. Elliott, Ph.D., is with RAND Health, Santa Monica, CA. Andrea Richardson, M.P.H., is with the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, NC. Paula Lozano, M.D., M.P.H., and Rita Mangione-Smith, M.D., M.P.H., are with the Center for Child Health, Behavior, and Development, Seattle Children's Hospital Research Institute, University of Washington, Seattle, WA.

  • Marc N. Elliott,

    1. RAND Health, Santa Monica, CA
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  • Andrea Richardson,

    1. Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, NC
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  • Paula Lozano,

    1. Center for Child Health, Behavior, and Development, Seattle Children's Hospital Research Institute, University of Washington, Seattle, WA
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  • Rita Mangione-Smith

    1. Center for Child Health, Behavior, and Development, Seattle Children's Hospital Research Institute, University of Washington, Seattle, WA
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Abstract

Objective. To examine the association between care experiences and parent ratings of care within racial/ethnic/language subgroups.

Data Source. National Consumer Assessment of Healthcare Providers and Systems Benchmarking Database 3.0 (2003–2006).

Sample Characteristics. 111,139 parents of minor Medicaid managed care enrollees.

Study Design. Cross-sectional observational study predicting “poor” (0–5 on 0–10 scale) parent ratings of personal doctor, specialist, health care, and health plan from care experiences for different parent race/ethnicity/language subgroups (Latino/Spanish, Latino/English, white, and black).

Principal Findings. Care experiences had similar associations with the probability of poor parent ratings of care across the four racial/ethnic/language subgroups (p>.20). A one standard deviation improvement in the doctor communication care experience was associated with about half the frequency of poor ratings of care for personal doctor and health care in all subgroups (p<.05). Sensitivity analysis of individual communication items found that failure to provide explanations to children predicted poor ratings of care only among whites, who also weighed the length of physician interaction more heavily than other subgroups.

Conclusions. Communication-based interventions may improve experiences and ratings of care for all subgroups, although implementation of these interventions may need to consider preferences associated with race, ethnicity, and language.

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